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Nursing problems after supplementing with breast milk

My son is 4 weeks old, and after his two week check-up he had not regained his birth weight (born at 8lbs 8oz, at 2 weeks was 7lbs 12oz). I was EBF, and my Doc ask that I give him 2oz of formula after I nurse him to help him gain weight. I didn't want to give him formula, so I started pumping and giving him breast milk after nursing sessions. He gobbled down the bottles and has progressively taken more and more in the bottles (from 1.5oz at the beginning to almost 4oz now). I also had extremely sore nipples and sought the advise of a lactation consultant at 3 weeks. She helped with the latch which is now good on the left and still painful on the right. She also suggested I continue the top-offs with the bottle due to my son's inadequate weight gain in the first 2 weeks. He has gained weight well since then (now 9lbs 10oz), but he is now impatient at the breast and cries and thrashes about after 5 min on each breast. My left nipple is still very sore, and I'm in pain while nursing on that side. Our nursing sessions have gone from 15min on each side to barely 10min. My Doc doesn't see a problem if he is gaining weight, but I'm sure he will reject my breast all together for the bottle if things continue this way. I plan on going back to the lactation consultant, but would love some advice in the meantime. I really want to nurse my son for the long haul, but I keep running into problems.

Re: Nursing problems after supplementing with breast milk

My Doc doesn't see a problem if he is gaining weight, but I'm sure he will reject my breast all together for the bottle if things continue this way.

trust your instincts, This is exactly what does very often happen when supplements of any kind are introduced, even when they were entirely appropriate and needed, as it sounds was probably the case due to very slow gain. Unfortunately, you and your baby are following the classic pattern to full-on bottle feeding. It will take effort to get back on track but there is lots of good news. Because you smartly supplemented only with your expressed milk (and have done the work needed to do that) it sounds as if you have kept your producton in great shape via pumping. This is really, really important and leaves you in very good shape for fixing this problem quickly.

If you liked your IBCLC I suggest do not hesitate to see her again. Some issues require more than one visit this is entirely normal. You want to fix the latch on the one painful side and also get reassurance baby can transfer milk ok now. Once you know your baby can nurse efficiently, you can toss the bottles and the pumping right out the window. Life will get waaay easier!

Here are some ideas to try if you like for the meantime
1) 4 ounces is not a ‘top off.’ That would be an entire feeding for a one month old, and a very large one at that. Babies this age would normally get anywhere from 1 to 4 ounces per feeding at the breast, and the amount would normally vary over the day. So a top off would be one to two ounces at the very very most. Just because a baby will take 4 ounces in the bottle does not mean baby needs it!
So make sure supplemental bottles are being given in a breastfeeding supportive way, which means slowly, carefully following baby's cues. This may help prevent baby getting used to very fast, large bottle feedings and slow down the tendency toward breast refusal. http://www.llli.org/docs/00000000000...astfedbaby.pdf
2) instead of supplementing after nursing, supplement a small amount (an ounce) prior to nursing so baby can finish at the breast, thus associating the breast with satiety and comfort.
3) A lactation aid (at the breast supplementer) is probably not indicated because the issue is not low production but rather, poor latch. However, it is something to consider if you cannot wean from supplemental feedings very soon.
4) nurse very frequently. A 4 week old infant normally needs to nurse at least 10-12 times in 24 hours. That is the minimum. When a baby starts getting larger bottle feedings, nursing sessions can become less frequent. You don't want that. You want everything to stay as close to 'breastfeeding normal' as possible. This means, very frequent, small feedings, offering the breast at the earliest cue, or even at no cue-just when you feel like it. Calm babies nurse better.

I don't know what you have tried for the painful latch. Here are my favorite latching and positioning ideas, check out what you like.
Tips on latch and positioning http://www.llli.org/faq/positioning.html